April 8, 2014 - When Ruth Tarantine’s mother was admitted to the ICU after developing asthma-related complications, she was confident that she could navigate her mother’s health care experience without difficulty. After all, Tarantine, DNP, RN, a nursing professor at a private university, had 25 years of nursing experience, including 17 years in the ICU.

Ruth Tarantine, RN, DNP, nursing professor and critical care nurse, was astonished to discover how difficult the health care system was to navigate when her mother became an ICU patient. She wrote Against All Odds about her family's experience.

“I thought I could navigate her through the hospitalization and help her understand what was going on. I believed that because I knew the health care environment so well, that mistakes wouldn’t happen to her,” commented Tarantine. “I have five siblings and we were present and actively involved in her care. I thought we could navigate the system effectively and she would not become a statistic.”

Three weeks into her mother’s hospital stay, Tarantine came to the stark realization that the journey was not going to be that easy.

“My mother was very vulnerable,” she said. “I found that the health care system that I thought worked well most days, wasn’t working well. I don’t know any providers who deliver care with malice, but the processes involved that were failing were astonishing to me.”

One of the most surprising things Tarantine discovered through her family’s experience was that the care she and her colleagues considered patient-centered was still provider-centered.

“Patients arrive in the hospital, sign a consent and release form and are then relegated to the role of health care recipients, not welcomed as partners in their own care,” she explained. “Clinicians would come into the room and explain what was about to be done. They were sharing information, but they were not collaborating. Decisions were made for my mother and our family and we weren’t included in those decisions until we spoke up.”

“I wrote my book, Against All Odds: How to Move from Provider-Centered Care to Patient-Centered Care, for two reasons,” Tarantine continued. “One was to help patients and families advocate for themselves. The other was because I wanted to say to my peers and colleagues, ‘Let’s step back for a minute and be mindful of the care we are delivering.’”

Tarantine says that she learned more during her mother’s two-and-half-year journey through the health care system than she did in all her years of formal education.

“When I had to cross the line from nurse to patient advocate, it really changed me. I now look at health care and the patient experience very differently,” Tarantine reflected.

“None of the issues I encountered were specific to the place or hospital I was in, but my global beliefs as a nurse were challenged along the way,” she continued. “I realized that I wasn’t seeing the fundamental concepts from school about patient-centered care operationalized. I began to see clearly that clinicians were doing things based on their timelines, preferences and what they believed to be correct--not necessarily based on what the patient wanted.”

Tarantine found her mother's experience a real wake-up call, especially seeing how elderly patients are often unable to speak for themselves. Consequently, she and her attorney brother, Richard, started Eldercare Navigators, LLC. Together, they help elders and their families access resources and navigate the complex health care and legal maze.

A fresh approach to patient-centered care

Tarantine suggests two things that nurses can do to move their care toward being more patient-centered: (1) include patients in developing their plan of care; and (2) remember that patients are moving along a care continuum.

“When we invite patients and families to speak into and make decisions about their plan of care, not only does our care become more patient-centered, but their odds of adhering to the plan are greatly increased,” she explained.

“Additionally, my experience participating in my mother’s care taught me the importance of recognizing the care continuum,” Tarantine continued. “As nurses we need to stop the mentality that says, ‘I’m discharging the patient, now they belong to someone else.’ I’d say we need to change our language from discharging to transitioning.”

“Particularly now with accountable care organizations and CMS’s 30-day readmission rule, we must increase communication with other nurses along the continuum to improve patient care,” she stressed.

While Tarantine issues a call for health care providers to strive for true patient-centered care, she recognizes that for the time being the onus of ensuring this kind of care rests on patients and family members.

“In my book, I talk about what family members need to navigate the health care system, and it isn’t medical knowledge,” she offered. “What you need is persistence, perseverance and to be present with your loved one. Asking questions and being involved in developing the plan of care are some of the most powerful things you can do to help a family member get better.”